READING SUB-TEST – QUESTION PAPER: PARTS B & C...SAMPLE READING SUB-TEST – QUESTION PAPER: PARTS B & C TIME: 45 MINUTES INSTRUCTIONS TO CANDIDATES DO NOT open this Question Paper

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READING SUB-TEST – QUESTION PAPER: PARTS B & C

TIME: 45 MINUTES

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www.occupationalenglishtest.org © Cambridge Boxhill Language Assessment – ABN 51 988 559 414

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 01/16

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Part B

In this part of the test, there are six short extracts relating to the work of health professionals. For questions 1-6, choose the answer (A, B or C) which you think fits best according to the text.

A

B

C

1. Doctors are advised to break patient confidentiality if

failure to do so would put other people in danger.

they inform the patient of their intention in advance.

a patient refuses to disclose information relevant to their care.

Patient Confidentiality

Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality,

patients may be reluctant to seek medical attention or to give doctors the information they need in order

to provide good care.

However, faced with a situation in which a patient’s refusal to consent to disclosure leaves others

exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining

confidentiality, or if it is not practical or safe to seek the patient’s consent, information should be

disclosed promptly to an appropriate person or authority. The patient should be informed in advance that

the doctor will be disclosing the information, provided this is practical and safe, even if the doctor intends

to disclose without the patient’s consent.

Fill the circle in completely. Example:

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A

B

C

2. According to the guidance notes, all staff involved in transferring patients from critical to general care must

obtain all necessary consent from any interested parties.

ensure that the patient’s personal care plan is also transferred.

make arrangements for ongoing co-operation once the transfer is complete.

Transfer of patients

1.15

The critical care area transferring team and the receiving ward team should take shared responsibility for

the care of the patient being transferred. They should jointly ensure that:

• there is continuity of care through a formal structured handover from critical care area staff to ward

. staff (including both medical and nursing staff), supported by a written plan;

• the receiving ward, with support from critical care if required, can deliver the agreed plan.

1.16

When patients are transferred to the general ward from a critical care area, they should be offered

information about their condition and encouraged to actively participate in decisions that relate to their

recovery. The information should be tailored to individual circumstances. If they agree, their family and

carers should be involved.

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A

B

C

To: Hospital staff

Re: Nutrition screening

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SAMPLEThis is to remind staff of the importance of nutrition screening to identify problems which may go unrecognised

and, therefore, remain untreated during the patient’s hospital stay. Nutrition screening should occur on

admission and then weekly during the patient’s episode of care; at least monthly in slower stream facilities; or if

the patient’s clinical condition changes.

All patients should have their weight and height documented on admission, and weight should continue to

be recorded at least weekly. Patients whose score is ‘at risk’ on a validated screening tool or whose clinical

condition is such that their treating team identifies them as at risk of malnutrition should be referred to a

dietitian for a full nutrition assessment and nutrition support as appropriate.

Memo

3. The memo says failure to screen a patient for malnutrition may result in

a change in overall health.

a prolonged stay at the care facility.

care providers being unaware of an issue.

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A

B

C

4. This policy document states that nurses

must sign a paper form if they want any new stock.

can order medicines from the pharmacy in some cases.

should speak to the pharmacist if a drug is needed urgently.

Stock requisitioning

If stock levels of a medicine are low, the nurse should firstly liaise directly with their ward-based team to

arrange urgent stock replenishment. If the ward-based team is unavailable, the nurse should complete

a request form online and email it to the pharmacy stores. Paper-based ordering systems are available

(e.g. the ward medicines requisition book); however these should not be relied on if ward stock is urgently

needed.

“At risk medicines” – Diazepam/Codeine Phosphate/Co-codamol – may only be ordered for stock when

a paper requisition is written. Paper-based requisitions should be complete, legible and signed, and then

sent to the pharmacy department.

Wards/clinical areas using Mediwell 365 cabinets will have orders transmitted automatically to Pharmacy

on a daily basis, as stock is used.

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A

B

C

5. The extract from the guidelines states that

ICU staff can be seconded to other wards.

only a consultant can refer a patient to the ICU.

the ICU is fully responsible for a patient in their care.

6.2 Intensive Care Unit (ICU)

6.2.1 Unplanned admissions to the ICU need a referral at consultant level. In exceptional circumstances,

referrals will be discussed with the Ward Registrar looking after the patient if a delay in referral to ICU

would lead to the rapid deterioration of a patient.

6.2.2 All patients discussed with the ICU staff but not admitted remain under the care of the primary team

and as such they remain responsible for reviewing and escalating care should deterioration occur.

6.2.3 We encourage collaborative patient-centred care. However the ICU is defined as a closed unit.

This means that when patients are admitted into the ICU, they are under the care of the ICU team. It is

expected that members of the primary referring team will liaise daily with the ICU team to discuss the

patient’s management. However, it is up to the ICU team to make final decisions.

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A

B

C

6. When dealing with patients following a safety incident, staff must avoid

saying anything until the facts have been established.

speculating on the possible causes of the incident.

contradicting what has been said by other staff.

Patient Safety Incidents

Information about a patient safety incident must be given to patients and/or their carers in a truthful

and open manner by an appropriately nominated person. Patients want a step-by-step explanation of

what happened that considers their individual needs and is delivered openly. Communication must also

be timely – patients and/or carers should be provided with information about what happened as soon

as practicable. It is also essential that any information given is based solely on the facts known at the

time. Healthcare staff should explain that new information may emerge as an incident investigation is

undertaken, and patients and/or their carers will be kept up-to-date with the progress of an investigation.

The Duty of Candour Regulations require that information be given as soon as is reasonably practicable

and be given in writing no later than 10 days after the incident was reported through the local systems.

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Part C

In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the answer (A, B, C or D) which you think fits best according to the text.

Text 1: Allergic to eating

Lucy Smith was strolling through Canberra last July. Within moments she couldn't stand, gripped by pain so severe

she feared she would pass out – the first sign of paralysing diarrhoea. This dramatic episode turned out to be

caused by a newly-acquired food allergy – to red meat. Food allergies affect one per cent of the adult population of

Australia. Most don’t hit with the same force as Lucy's, but the physical and mental impact can nonetheless turn a

person's life upside down, and may even be life-threatening. Lucy deduced that she was allergic to red meat, one

of the less common allergenic foodstuffs. Only after several further attacks of varying severity, was her suspicion

eventually confirmed by a specialist.

An allergy, according to immunologists, is the immune system over-reacting to a substance that would ordinarily

be considered benign. However the term 'allergy' is used more loosely by the general public. People say they

are allergic to a substance because it brings about some kind of adverse reaction in their bodies, some of which

can be severe and may resemble true allergic reactions, but unless the immune system itself is directly involved,

experts categorise it as 'intolerance'. Constant sneezing, itchy eyes or throat and inner ears, asthma, rashes, and

diarrhoea can all be signs of food allergies. Intolerance can bring on similar warning signs as well as things such as

headaches, bloating, and general lethargy. Over time, some allergy sufferers lose weight because there are so few

foods they can eat. Of course the social implications are huge too – eating is a major social event.

To diagnose a food allergy, immunologists use a 'skin-prick test' in which a drop of a commercially extracted

allergen is placed on the skin and the first couple of skin layers are pricked with a lancet. If a person is allergic,

the immune system is stimulated sufficiently to produce a mosquito bite-like bump within fifteen minutes. This

testing method is, however, somewhat unreliable in detecting intolerances, because, while not fully understood,

they operate via a different biological mechanism possibly involving chemicals in food irritating nerve endings

in the body. They are generally diagnosed by following an exclusion diet in which suspect foods are gradually

reintroduced and their effects monitored.

Fill the circle in completely. Example:

ABC

D

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According to paediatric immunology specialist Dr Velencia Soutter, around six to eight per cent of babies are

affected by allergy. While most children will outgrow them, some actually grow into them. The mechanisms that

provoke an allergy remain a grey area. Soutter says: 'It’s like throwing a match into a fireworks factory. Hit the right

place and you set off a chain reaction. Miss it and the match just fizzles out. That difference between lighting up or

fizzling out isn’t well understood.'

Broadly speaking, Dr Soutter says the ideal recipe for a food allergy is to be born of allergic parents and then

to have a high exposure to an allergenic foodstuff. But there are so many exceptions to this rule that other

forces are clearly at work, and who’s to say what 'high' exposure is anyway? In contrast, the so-called hygiene

hypothesis suggests too low an exposure to allergens is to blame. The idea is that today's clean environments

leave our immune systems with too little to do, encouraging them to turn on the wrong culprits. Clearly, the field of

immunology has only just scratched the surface of understanding.

Interesting flakes of information are gradually being peeled off that surface, however. There is evidence that

allergens can be transferred through a mother's breast milk to her child, and possibly also through the placenta.

Since the immaturity of babies' immune systems might make them more vulnerable to an inherited allergic

tendency, women in allergic families could be advised to avoid certain foods during pregnancy and breastfeeding. It

is possible, though, that some allergies or intolerances are purely imaginary and this can also have consequences

for children. One US study found that parents sometimes avoided foods to which they erroneously believed their

children were allergic, occasionally leaving the children severely underfed.

In Australia, the number of people with genuine and severe allergies is growing. Some doctors speculate whether

the increased amount of new chemicals in the environment and in food is perhaps damaging immune systems

− making them more prone to react adversely. Much more research needs to be done to provide evidence for

that hypothesis. Anecdotally though, some experts say that staying off processed foods resolves the problem in

a significant number of cases. Dr Soutter speculates that a rise in peanut allergy cases makes up the bulk of the

increase in food allergies. Greater exposure has probably allowed more peanut allergies to flourish, she thinks.

Peanut consumption per capita is rising. It's a common ingredient in Asian and vegetarian dishes, which have

grown in popularity, and the diet-conscious population is increasingly turning to nuts as a source of healthy fats.

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Text 1: Questions 7-14

A

B

C

D

A

B

C

D

A

B

C

D

A

B

C

D

7. The case of Lucy Smith highlights the fact that food allergies

may be difficult to diagnose in certain people.

are relatively rare in the adult population.

can cause debilitating symptoms.

often require urgent treatment.

8. In the second paragraph, what point is made about food intolerances?

Scientists continue to disagree about their root causes.

The symptoms are indistinguishable from those of allergies.

They can have an unpredictable impact on the person affected.

The distinction between them and allergies is not widely appreciated.

9. The phrase ‘via a different biological mechanism’ in the third paragraph explains

the way the skin-prick test works in diagnosing food intolerances.

how the presence of food impurities impacts on the skin-prick test.

why the skin-prick test may not accurately diagnose food intolerance.

how food allergies are triggered by substances used in the skin-prick test.

10. Dr Soutter uses the image of a fireworks factory to illustrate that

the factors triggering an allergic reaction still remain unclear.

allergic attacks can occur suddenly any time in a person’s life.

it’s difficult to foresee which family member an allergy will affect.

the identification of a food allergy is basically a matter of chance.

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A

B

C

D

A

B

C

D

A

B

C

D

A

B

C

D

11. In the fifth paragraph, what point is made about the two hypotheses mentioned?

They both appear to be credible.

They directly contradict each other.

They fail to define their terms adequately.

They should both be studied in more depth.

12. What does the phrase ‘this rule’ in the fifth paragraph refer to?

the likelihood of having an inherited allergy to certain foods

the type of diet in which food allergies more commonly occur

the degree of contact with allergens needed to trigger a reaction

the order of events most commonly found prior to allergic attacks

13. What does the sixth paragraph suggest about the transference of allergies between mother and child?

It is only possible with particular individuals.

It can result in instances of malnourishment.

It may be avoidable if certain precautions are taken.

It is most likely to take place before the baby is born.

14. Dr Soutter suggests that the rise in cases of one allergy may be partly due to

attempts to improve eating habits.

changes in food manufacturing methods.

the adoption of new agricultural practices.

increased levels of harmful substances in the atmosphere.

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Text 2: Prenatal origins of heart disease

Heart disease is the greatest killer in the developed world today, currently accounting for 30% of all deaths in

Australia. A concept which is familiar to us all is that traditional risk factors such as smoking, obesity, and genetic

make-up increase the risk of heart disease. However, it is now becoming apparent that another factor is at play – a

developmental programming that is predetermined before birth, not only by our genes but also by their interaction

with the quality of our prenatal environment.

Pregnancies that are complicated by sub-optimal conditions in the womb, such as happens during pre-eclampsia or

placental insufficiency, enforce physiological adaptations in the unborn child and placenta. While these adaptations

are necessary to maintain viable pregnancy and sustain life before birth, they come at a cost. The biological trade-

off is reduced growth, which may in turn affect the development of key organs and systems such as the heart and

circulation, thereby increasing the risk of cardiovascular disease in adult life. Overwhelming evidence in more than

a dozen countries has linked development under adverse intrauterine conditions leading to low birth weight with

increased rates in adulthood of coronary heart disease and its major risk factors – hypertension, atherosclerosis

and diabetes.

The idea that a foetus’s susceptibility to disease in later life could be programmed by the conditions in the womb

has been taken up vigorously by the international research community, with considerable efforts concentrating on

nutrient supply across the placenta as a risk factor. But that is just part of the story: how much oxygen is available

to the foetus is also a determinant of growth and of the risk of adult disease. Dr Dino Giussani’s research group

at Cambridge University in the UK is asking what effect reduced oxygen has on foetal development by studying

populations at high altitude.

Giussani’s team studied birth weight records from healthy term pregnancies in two Bolivian cities at obstetric

hospitals and clinics selectively attended by women from either high-income or low-income backgrounds. Bolivia

lies at the heart of South America, split by the Andean Cordillera into areas of very high altitude to the west and

areas at sea-level to the east, as the country extends into the Amazon Basin. At 400m and almost 4000m above

sea-level, respectively, the Bolivian cities of Santa Cruz and La Paz are striking examples of this difference.

Pregnancies at high altitude are subjected to a lower partial pressure of oxygen in the atmosphere compared with

those at sea-level. Women living at high altitude in La Paz are more likely to give birth to underweight babies than

women living in Santa Cruz. But is this a result of reduced oxygen in the womb or poorer nutritional status?

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What Giussani found was that the high-altitude babies showed a pronounced reduction in birth weight compared

with low-altitude babies, even in cases of high maternal nutritional status. Babies born to low-income mothers at

sea-level also showed a reduction in birth weight, but the effect of under-nutrition was not as pronounced as the

effect of high altitude on birth weight; clearly, foetal oxygenation was a more important determinant of foetal growth

within these communities. Remarkably, although one might assume that babies born to mothers of low socio-

economic status at high altitude would show the greatest reduction in birth weight, these babies were actually

heavier than babies born to high-income mothers at high altitude. It turns out that the difference lies in ancestry.

The lower socio-economic groups of La Paz are almost entirely made up of Aymara Indians, an ancient ethnic

group with a history in the Bolivian highlands spanning a couple of millennia. On the other hand, individuals of

higher socio-economic status represent a largely European and North American admixture, relative newcomers

to high altitude. It seems therefore that an ancestry linked to prolonged high-altitude residence confers protection

against reduced atmospheric oxygen.

Giussani’s group also discovered that they can replicate the findings observed in Andean pregnancies in hen

eggs: fertilised eggs from Bolivian birds native to sea-level show growth restriction when incubated at high altitude,

whereas eggs from birds that are native to high altitude show a smaller growth restriction. Moving fertilised eggs

from hens native to high altitude down to sea-level not only restored growth, but the embryos were actually larger

than sea-level embryos incubated at sea-level. The researchers could thereby demonstrate something that only

generations of migration in human populations would reveal. What’s more, when looking for early markers of

cardiovascular disease, the researchers discovered that growth restriction at high altitude was indeed linked with

cardiovascular defects – shown by an increase in the thickness of the walls of the chick heart and aorta. This all

suggests the possibility of halting the development of heart disease at its very origin, bringing preventive medicine

back into the womb.

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Text 2: Questions 15-22

A

B

C

D

A

B

C

D

A

B

C

D

A

B

C

D

15. What information can be found in the first paragraph?

reference to some recent findings relating to heart disease

indication of the greatest risk factor associated with heart disease

mention of a misconception about the chief causes of heart disease

figures showing the country with the highest mortality rate from heart disease

16. When the writer uses the word ‘cost’ in the second paragraph she is referring to

overwhelming evidence.

placental insufficiency.

viable pregnancy.

reduced growth.

17. In the third paragraph, what does the author suggest about the work of the international researchcommunity on this subject?

Their focus has been too narrow.

Some of their studies may be flawed.

There is nothing original about their research.

They were overly keen to seize on a particular idea.

18. What was the aim of the study described in the fourth paragraph?

to compare neonatal records between the UK and Bolivia

to assess the relative significance of two risk factors for newborns

to find a link between birth weight and predisposition to heart disease

to determine the likelihood of high-altitude babies being carried to full term

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A

B

C

D

A

B

C

D

A

B

C

D

A

B

C

D

19. What assumption was proved wrong by the results of the study?

Lower-income mothers generally give birth to lower weight babies.

A baby born at high altitude will typically weigh less than one born at sea level.

Levels of oxygen have a greater impact on birth weight than nutritional status does.

There is a correlation between prenatal oxygen levels and predisposition to heart disease.

20. In the sixth paragraph, what is suggested about the inhabitants of La Paz?

The altitude affects all socio-economic groups in a similar way.

There is a high degree of ethnic diversity at all levels of society.

Most residents have a shared ancestry going back two thousand years.

Poorer residents have a genetic advantage over those with higher incomes.

21. The purpose of the information in the sixth paragraph is to provide

an alternative approach to a puzzle.

a confirmation of a hypothesis.

an explanation for a finding.

a solution to a problem.

22. What advantage of the research involving hen eggs is mentioned in the final paragraph?

the availability of supplies

the simplicity of the procedure

the reliability of the data obtained

the speed with which results are seen

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READING SUB-TEST – QUESTION PAPER: PARTS B & C...SAMPLE READING SUB-TEST – QUESTION PAPER: PARTS B & C TIME: 45 MINUTES INSTRUCTIONS TO CANDIDATES DO NOT open this Question Paper